My work is all about improving health and health care through knowledge. It spans medical publishing to community health, taking in technology and innovation, and is influenced by growing up in a working-class community. I share insights from all of the above through public speaking.

May 18 The White Working Class

At our Board meeting one of the Board asked us who we feel "emotionally responsible" to. It was part of an exercise to help us think about who is missing from the Board, what demographic we think we need represented in our efforts to bridge health systems and local communities.

Being a second generation immigrant (from India) I suspect the assumption is that I'd feel responsible to my community. I do in almost all areas of my life but when it comes to my work it's the white working class that rise to the top. It's them I feel most emotionally responsible to.

That probably seems odd to some people (perhaps most). Minorities are supposed to stand up for their 'brothers and sisters'. We've experienced the injustices that have been endured, often in silence, and now we're getting louder in demanding an end to structural prejudice. Surely I should prioritise adding my voice to that chorus, the chant for equity?

Perhaps.

But I can't help noticing the impact of immigration and globalisation on white working class communities. My father once told me that many immigrants from India and Pakistan got their opportunity for work when white people demanded better working conditions through their unions. The factory owners saw an opportunity to fire anyone unionised and recruit the new immigrants who were hungry for work, the working conditions being better than anything they'd experienced 'back home'. That way, the factory owners 'defeated' the unions and maximised their profits.

It's easy to say that the communities within the working classes were pitted against each other, all to the benefit of the privileged. But there's more to it than that. Many unions at that time - the 60s and 70s - were hostile to new immigrants, their raison d'être seeming more to protect their existing members than welcome new ones from different cultures. As a result, they were not representative of the working class, as a whole, just the ones they decided were ok.

That's not to say that the white working class is responsible for its own downfall. Only that, as ever, the picture is more nuanced and complex than meets the eye.

Of course, more compliant labour also existed 'off shore' so they - like all working class communities in high income countries - have suffered at the hands of globalisation, specifically, 'out sourcing' (as an aside, it does make me laugh that the very economists that pushed globalisation and outsourcing are now banging on about 'shared value', taking chutzpah to whole new levels; for me, they're the crooks who've dodged the ire of communities that have been tossed aside by their inhuman 'research').

I understand that to describe both Brexit and Trump (and the rise of Wilders in the Netherlands and Le Pen in France, even if they didn't win - for now) solely as a backlash by the white working class would be inaccurate. And yet, at the same time, it's pretty clear that 'traditional' parties had little to offer the white working classes. On a macro scale, globalisation has been good, lifting many in low- and middle-income countries out of extreme poverty, but that means little to the white person who took what education was offered until 16 and then decided to find work, only to be told that the world had changed and they were no longer needed.

I write all this knowing full well that the political scientists out there will find me naive. But I can only call as it as I've seen and experienced it. To walk among the empty factories of Leicester, their windows smashed, their silence betrayed by the music coming from squatters, is to feel the pain of a community abandoned. I remember those places as vibrant, almost scary. The energy was part of life. And it now seems to me that it was the energy of salutogenesis, the power to create meaning and coherence.

My final thought is how poorly those in power are responding to the supposed backlash of the white working class. The demonsising of those communities as ignorant, racist and stupid says more about the ignorance, prejudice and stupidity of those demonising than those being demonised. It's going to take bravery to repair the wounds inflicted over 40 or 50 years, those wounds being no less legitimate than those inflicted on people of colour (especially in the US) for generations.

All in all, it's the white working class that I feel "emotionally responsible" to in my work. Not exclusively, but they're the ones I feel the responsibility to most.

Pritpal S Tamber

I’m the Co-Founder & CEO of Bridging Health & Community (BH&C) and the Founder of the Creating Health Collaborative. Before all this, I was the Physician Editor of TEDMED, Medical Director of Map of Medicine, Editorial Director for Medicine at BioMed Central, the company that pioneered open access publishing, and an editor at the BMJ. I have an MBChB (the UK equivalent to an MD) from the University of Birmingham, UK. This is my personal blog. If you're interested in BH&C or the Collaborative, check out the BH&C website, including the updates, which you can receive by email. My speaking agent in the US is Executive Speakers Bureau and in Europe is Maria Franzoni Ltd.